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In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock
M A König1, S Hediger1, J W Schmitt1
1Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Summary
Iliosacral screw fixation with in-screw cement augmentation (ISFICA) offers a promising solution for posterior pelvic ring pathologies, especially in patients with poor bone quality. This technique demonstrates safety, precision, and positive initial outcomes, warranting further investigation.
Area of Science:
- Orthopedic surgery
- Surgical techniques
- Biomaterials
Background:
- Posterior pelvic ring pathologies often require screw fixation.
- Poor bone quality can compromise screw anchorage in these treatments.
- A novel technique, iliosacral screw fixation with in-screw cement augmentation (ISFICA), was developed to address these challenges.
Purpose of the Study:
- To detail the ISFICA technique for treating posterior pelvic ring pathologies.
- To evaluate the safety, precision, and initial outcomes of ISFICA.
Main Methods:
- ISFICA involves guiding screw placement with a K-wire and applying bone cement through a specialized device.
- Intraoperative CT scans were used for immediate assessment of cement distribution, screw placement, and leakage.
- Twenty patients (mean age 74.4 years) received 26 ISFICA implants.
Main Results:
- All patients experienced immediate postoperative mobilization with reduced pain and no neurologic deficits.
- No cement leakage was observed, though one case of iliac cortical breach occurred due to osteoporosis.
- One screw migration and two cases of iliosacral joint arthropathy requiring screw removal were noted after one year.
Conclusions:
- ISFICA shows significant promise for safety, precision, and initial postoperative results in treating posterior pelvic ring pathologies.
- Further studies with larger cohorts are needed to assess long-term mechanical stability and pain reduction.
- Long-term screw loosening despite cement augmentation requires continued investigation.
